September 6, 2010


ME + me :  Brit. Jn. Psychiatry: 78% of the British are not sane

I continue being not well but because I yesterday wrote - in effect - on the irrationality of psychiatry in the US, I could not refrain myself today from listing an interesting piece by Neuroskeptic, who has a nice blog on neuroscience, entitled 'Normal? You're weird - Psychiatrists', that starts of thus:

Almost everyone is pretty screwed up. That's not my opinion, that's official - according to a new paper in the latest British Journal of Psychiatry.

Make sure you're sitting down for this. No less than 48% of the population have "personality difficulties", and on top of that 21% have a full blown "personality disorder", and another 7% have it even worse with "complex" or "severe" personality disorders.

That's quite a lot of people. Indeed it only leaves an elite 22.5% with no personality disturbances whatsoever. You're as likely to have a "simple PD" as you are to have a normal personality, and fully half the population fall into the "difficulties" category.

Neuroskeptic also makes clear what's wrong with that paper (in his and my opinion, to be sure) and fields some comments quite well.

I do want to make two somewhat critical remarks, of which the first is terminological nit-picking:

First, the new DSM, unlike the previous ones, is numbered by an Arabic not a Roman number. It confused me too, initially, but the correct - even trademarked - name is "DSM-5", or so I have read on the internet in prose of people who should know.

Second, he writes

They suggest that in the upcoming DSM-V revision of psychiatric diagnosis, it would be useful to formally incorporate the severity spectrum in some way - unlike the current DSM-IV, there everything is either/or.

Here his given link is to an interesting site, from which I quoted some that underlines why I wrote about the DSM-5 yesterday:

"The publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is one of the most highly anticipated events in the mental health field," explains Managing Editor Daniel Falatko. "This is the first major rewrite of DSM in 16 years and history has warned us that even small changes to this manual can have extraordinary repercussions in the diagnosis and treatment of mental health issues."

Quite so, indeed - and this also explains why this elderly psychologist only got (somewhat) acquainted with DSM-III, that incidentally also did not much impress him, but which he could and can see the need for, namely for the eminently rational and scientific purpose to have similar symptoms at least labelled in the same way. (*)

To return to the last quote by Neuroskeptic, who reports that the authors of the paper according to which, if you happen to be British, there is a chance higher than 3 in 4 that a British psychiatrist will diagnose you with a personality disorder, suggest that in the DSM-5

"it would be useful to formally incorporate the severity spectrum in some way - unlike the current DSM-IV, there everything is either/or."

Not so, I think, being also a philosopher of science: A main part of the original reasons for setting up the DSM was to have similar symptomatology - for psychiatrists usually do NOT have a neurologically based explanation for psychiatric conditions, but only a set of interrelated labels - possibly held together by some vague verbal psychiatric theorizing (**) -  that in its turn is connected with a set of possible therapies or medicines that may alleviate the symptoms or the conditions that lead to them - judged in similar terms and treated in similar ways.

Now this was a fine scientific end: To understand things, the first thing necessary is to mostly agree on the terms to discuss them, and to be consistent and uniform in that, so that a GP may know what a psychiatrist means, rather than - as was more or less the case before the DSM - having to look into some library to find out what a psychiatrist of a certain school might mean by "neurosis" or "personality disorder", and also with the end in view that similar symptoms get similar treatments in different hospitals and from different doctors, not because that treatment would necessarily be the right or a helpful treatment, but to be able to establish empirically whether that treatment would help.

Therefore, if the DSM-5 will insist on limbering up precise terminological divisions, and return to vague qualitative judgments of severity or seriousness, or the lack thereof, most of the basic justification for having a DSM - a Diagnostic and Statistical Manual of Mental Disorders - will have been left, effectively, and real objective empirically based mathematical statistics will have little to do with it anymore.

That is an important enough conclusion to write out, and here is a related point, that in fact is simultaneously moral, logical, methodological and statistical, which I again give in Neuroskeptic's words, in a comment of his to a comment to his post:

Even if everyone in the world became really fat, we would still be unusually fat, because we would be fatter than people from previous generations.

However this survey isn't comparing people to any real healthy baseline. It's comparing people to the ideal baseline of "not answering yes to any of these questions". What the data show is that it is normal not to meet that ideal.

That either means we're all screwed up, or it means the ideal is unrealistic. Given that the ideal is something dreamed up by a bunch of psychiatrists who wrote DSM-IV (and even they didn't intend personality disorder criteria to be used in this way) I suspect it's the latter.

In fact it's not just that the theory that informed the symptomatology that can be found in DSM-IV and was used by the authors of the paper that implied 78% of the British is not really mentally sane should be considered as refuted by these data (if there are no methodological or statistical errors, to be sure), but also that the paper in the Brit. Jn. of Psychiatry shows a not very sane confusion of the menu and the diner, that is, a confusion of the terms for the facts and the facts themselves, for the authors argue as if the DSM-IV must be correct if the data they found contradict it, namely in the form of implying that 4 out of 5 British persons are not mentally sane.

P.S. This in fact continues yesterday's piece about the DSM-5, that today had some typos removed and also got some better formatting. (Ms. Chapman's text wasn't properly displayed in Microsoft IE because my Frontpage doesn't do tables uniformly for both Firefox and Microsoft IE. It should be OK now.)

There also turns out to be today an interesting piece by Neuroskeptic, who tries to unravel some of the XMRV-story. Here is the link: A PCR Primer. This is quite helpful, also  in explaining Dr. Judy Mikovits' comments: Judy Mikovits reacts to the Lo/Alter paper (video),

P.P.S. It may be I have to stop Nederlog for a while. The reason is that I am physically not well at all. I don't know yet, but if there is no Nederlog, now you know the reason.


As to ME/CFS (that I prefer to call ME):

1. Anthony Komaroff

Ten discoveries about the biology of CFS (pdf)

3. Hillary Johnson

The Why

4. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf)
5. Eleanor Stein

Clinical Guidelines for Psychiatrists (pdf)

6. William Clifford The Ethics of Belief
7. Paul Lutus

Is Psychology a Science?

8. Malcolm Hooper Magical Medicine (pdf)

Short descriptions:

1. Ten reasons why ME/CFS is a real disease by a professor of medicine of Harvard.
2. Long essay by a professor emeritus of medical chemistry about maltreatment of ME.
3. Explanation of what's happening around ME by an investigative journalist.
4. Report to Canadian Government on ME, by many medical experts.
5. Advice to psychiatrist by a psychiatrist who understands ME is an organic disease
6. English mathematical genius on one's responsibilities in the matter of one's beliefs:
   "it is wrong always, everywhere, and for anyone, to believe anything upon
     insufficient evidence
7. A space- and computer-scientist takes a look at psychology.
8. Malcolm Hooper puts things together status 2010.

    "Ah me! alas, pain, pain ever, forever!

No change, no pause, no hope! Yet I endure.
I ask the Earth, have not the mountains felt?
I ask yon Heaven, the all-beholding Sun,
Has it not seen? The Sea, in storm or calm,
Heaven's ever-changing Shadow, spread below,
Have its deaf waves not heard my agony?
Ah me! alas, pain, pain ever, forever!
     - (Shelley, "Prometheus Unbound") 

    "It was from this time that I developed my way of judging the Chinese by dividing them into two kinds: one humane and one not. "
     - (Jung Chang)


See also: ME -Documentation and ME - Resources

P.P.S. ME - Resources needs is a Work In Progress that hasn't progressed today.

(*) Instead of, as happened well into the nineteenfifties, in Jungian or Freudian or Adlerian or Rankian or whatever psychiatric terminology the psychiatrist making the diagnosis had been educated in.

(**) And here it should be mentioned and strongly stressed that most psychiatric theorizing, from its origins at least since Freud to the present day, is not scientific; often is hardly rational (try reading Freud, Jung, or Ranke, if you doubt this); usually is quite untestable (which makes it something else than empirical science); normally is contradicted by other theories about the same phenomena by other psychiatrists; and is not related to neurology or the neurosciences (other than superficially), simply because to this very day there is no adequate neurology to explain human experience.

None of this would be bad, given that the human brain is the most complicated organ in known nature, and given that so far by far the greatest part of how the brain produces its marvels is not understood at all in neurological terms, if it were not for the fact that psychiatrists tend to pretend that their hardly scientific hypotheses and guesses, mostly untestable in principle and so in principle not empirical science at all, are adequate, correct or worthy explanations of the facts of human psychology and of human psychological and other problems.

Not so: In fact, neurology and psychiatry know less of the brain than was known about the geography of the earth in medieval times. That is, if there is a map of the territory, it is a very partial, very incomplete, for a considerable part false or misleading, and for the most part hypothetical map of the very incompletely known territory that is the living, feeling, desiring and believing human brain.

And this does not mean that there is no place for psychiatry - understood as the attempt by medical doctors to understand and help people with psychological problems - but it does mean that (1) psychiatry is at present an art rather than a science and (2) psychiatrists should be humble and forthright about their relative ignorance and inability to help instead of pretentious about the truth, validatity, tenability or usefulness of their psychiatric theorizing.

Even if they mean well and are very smart (some but not many psychiatrists are, in my experience, which is mostly of psychiatrics' writings to be sure, and undoubtedly a part of psychiatrists mean well, although patients do well to remember that even a good, kind, helpful and rational psychiatrist is doing psychiatry for the money rather than for other reasons), they simply do not have the neurological knowledge of the brain to make their guesses plausible. For such knowledge simpy does not exist today.

Indeed, most psychiatric theories I know of are not really testable in any rational scientific sense. This is not the fault of psychiatrists, but it turns into a serious personal fault, both morally and rationally, both medically and scientifically, if they insist that their beliefs, hypotheses and guesses are scientifically based systems of empirical knowledge about human experiencing. 

Maarten Maartensz

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